States raise concerns with ‘partnership’ models for exchanges

A meeting of state and federal health officials turned tense this week as state regulators raised objections to the Obama administration’s proposals for insurance exchanges.

A person who attended the two-day meeting said states complained about proposals for a “partnership” model in which states and the federal government would jointly operate some exchanges.

“The feds were more defensive than I have ever seen them,” the attendee said.

An administration official noted that the Department of Health and Human Services hasn’t framed its partnership proposals as an official, set-in-stone policy. The meeting, which concluded Tuesday, was billed from the beginning as a way for states and HHS to discuss the best ways forward on exchanges.

“The whole point of today’s meeting was to hear what states have to say so we can strengthen the partnership model, and we appreciate the comments and feedback we received,” the official said. “This is an ongoing dialogue.”

Among states’ objections: They were told that a partnership might technically have to be considered a federally run exchange. Although HHS clearly wants states to handle as much of their own exchanges as possible, a partnership would legally be considered a federal exchange. And that’s not how conservative governors want to describe the exchange to their constituents.

States also raised concerns about the merits of their options for a partnership model. They wanted a broader menu of options on the table, but HHS officials said they feared that would make the undertaking impossible.

“I just don’t know how they got it so wrong,” the attendee said of the HHS proposals.

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